656-P: Multidisciplinary Predialysis Team Education for Patients with Diabetic Nephropathy Produced Not Only Good Effects on the Hemodialysis Course, but Also Prolonged the Survival

To determine whether or not a multidisciplinary individual team approach (MTA) benefited the hemodialysis (HD) course and prognosis after HD induction in patients with diabetic nephropathy (DN), we compared the effect of an MTA on the HD course of 42 DN patients with that of 33 DN patients managed by a dietitian approach alone (DA) (n=75 total; 50 men, 62±12 years old; 73 with type 2 diabetes mellitus). In all cases, HD was initiated between January 2010 and June 2016. There were no significant differences in the HbA1c or age between the groups when serum creatinine (S-Cr) was 2.0 mg/dL at the study start. MTA staff members were doctors, dietitians, nurses, laboratory technologists, and pharmacists. The team provided broad education, including advice on nutrition, medication, medical exams, and foot care. The duration from S-Cr 2.0 mg/dL to HD induction was significantly longer in the MTA group (3.3±2.2 yrs) than the DA group (2.3±1.8 yrs; p=0.021). The MTA group had a shorter hospitalization for HD induction and lower cost per admission than the DA group (44±33 days vs. 32±20 days, p=0.035; $20,506 ±14,219 vs. $14,554 ± 826, p=0.019). Urine collection (24-h) was more frequent in the MTA group than the DA group (likelihood ratio 5.05; p=0.025). Patients with urine collection tended to live longer than those without it (8.2±3.1 yrs vs. 6.9±2.6 yrs, p=0.075). The CTR at the HD induction tended to be smaller in the MTA group than in the DA group (53.0±5.7% vs. 55.6±7.3%, p=0.057). The hematocrit value in the MTA group (29.2±4.6%) was significantly better than in the DA group (26.5±4.0%, p=0.004). A Kaplan-Meier survival analysis showed that the MTA group had a better survival than the DA group (log rank 4.430, p=0.035). An MTA provided multiple effects that postpone HD induction, better clinical HD course, cost reduction, and prolonged survival compared with a DA, even when observation was started at the same S-Cr level.